Feeling anxious or nervous before sex can result in erection and ejaculation issues, and affect sexual satisfaction. Sexual Performance Anxiety (SPA) affects sexual activity as fear overwhelms a person’s abilities before and during sex. It can be difficult to obtain or sustain an erection or make it difficult or impossible to climax.
While this disorder can affect both men and women, it is more prevalent among men. As many as 25% of men reported experiencing sexual performance anxiety compared to a maximum of 16% of women. Also, doctors reported more cases of SPA among young men who are otherwise healthy and exercised. It can be confusing for them when they experience sexual difficulties. Moreover, SPA can further develop into other sexual disorders including erectile dysfunction and losing interest in sexual activities.
What happens during sexual performance anxiety?
Before or during sexual intercourse, men may start feeling anxious and have erection issues, and the other symptoms of SPA are discussed later in this article. This happens when the sympathetic nervous system activates and starts to constrict blood vessels while producing more stress hormones. Blood pressure levels rise and blood flow to body parts including the penis is significantly affected.
Psychological issues may cause the body to not respond to a sexual stimulation like it used to. Even men who do not normally show signs of erectile dysfunction may suddenly have trouble getting their penis hard when they feel nervous or anxious about sex.
During sex, men with sexual performance anxiety experience anorgasmia. They find it difficult to concentrate on the sensations of sex. Therefore, it becomes increasingly difficult for them to achieve an orgasm. Experiencing these issues during sex can cause people who experienced SPA to have a decreased interest in sex, among other negative effects on their sex life.
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How is sexual performance anxiety diagnosed?
Sexual performance anxiety, albeit being a common sexual problem, is not in itself a diagnosis. Still, mental health professionals like psychiatrists and psychologists can identify this type of anxiety through an assessment of the signs and symptoms. Identifying sexual performance anxiety can prevent the occurrence of other sexual dysfunctions that follows after experiencing sexual difficulties or failures due to SPA.
It is equally important to know of misdiagnosis of sexual performance anxiety as erectile dysfunction. These are two very different conditions, though the symptoms may sometimes overlap. Diagnosis should take into consideration other factors including medical conditions that can diminish sexual performance.
Erectile dysfunction risk factors
Sexual performance anxiety is one of the known factors closely linked to developing sexual dysfunctions. Moreover, SPA may maintain sexual dysfunctions. SPA may affect a man’s self-esteem and cause stress. Men who had trouble with anxiety during sex may feel unworthy or incapable. Anxiety-linked ED may cause a self-perpetuating cycle that affects men’s sex life and cause relationship problems. Ignored and left untreated, sexual anxiety can lead to complete impotence.
Sexual Performance Anxiety vs. Erectile Dysfunction: Causes
Several factors contribute to experiencing anxiety before and during sex such as:
- Body image and self-esteem issues
- Worrying about height, weight, penis size, and partner satisfaction
- Lack of sexual experience
- A previous negative experience of sex or sexual trauma
- Conflict, dissatisfaction, and lack of emotional connection with your partner
- Stressors in non-sexual aspects of life (work, family, finances)
- Nervousness about sex
- Mental health conditions like generalized anxiety disorder and depression
- Overconsumption of pornographic content
On the other hand, the medical condition diagnosed as erectile dysfunction is the result of complex effects on men’s hormones, nerves, blood vessels, muscles, brain, and emotions. Some known factors that cause erectile dysfunction are:
- Vascular or heart disease
- Clogged blood vessels
- High blood pressure
- High cholesterol
- Type 2 diabetes
- Neurologic diseases
- Old age
- Obesity
- Metabolic syndrome
- Smoking, alcoholism, drug use
- Prostate cancer surgery side effects
- Surgery or injuries to the pelvic or back area
- Low-t (testosterone)
- Peyronie’s disease (penile curvature)
- Certain prescriptions
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How is sexual performance anxiety treated?
Mental health professionals will focus on identifying the reasons causing the anxiety. Performance anxiety may be fixed by solving the underlying causes of the anxiety. Some options that help resolve SPA are:
- Lifestyle changes – Losing weight, adopting a healthier diet, and quitting habits like substance use, smoking, and drinking alcohol can improve overall health and better erections.
- Therapy – Sex therapy or cognitive-behavioral therapy focuses on resolving intimacy and sexual performance issues. Therapists may teach techniques like mindfulness to reduce negative thinking and overall stress. These techniques focus on feeling the sensations in the present moment that may help manage SPA.
- Guided imagery – This technique teaches the body to overcome physical and mental issues by entering into a trance-like state of the unconscious mind. Sexual re-education and guided imagery may help overcome anxiety-related ED.
- Oral medications – The four common ED medications used to increase blood flow into the penis and relax blood vessels are avanafil, sildenafil, vardenafil, and tadalafil. These medications may improve the quality of sex, though may not by themselves produce an erection without stimulation. It is often prescribed to men who have no significant nerve damage.
- Penile injections – self-injected into the side of the penis 10 to 15 minutes before sex to aid in blood flow into the penis.
- Intraurethral suppositories – small pellets containing alprostadil are inserted into the urethra to aid in the erection. Side effects include feeling a burning sensation in the penis, pain during insertion, and minor bleeding.
- Penis pump or vacuum device – sucks air out to bring more blood into the penile tissue. Some men find this device inconvenient to use.
- Surgery – When SPA develops into severe ED, the body may not respond to treatments. As such, there is another option called penile implant surgery. A hydraulic device called an inflatable penile prosthesis is implanted into the penis along with a small pump inside the scrotum. Squeezing this pump may cause an erection.
Before you go
Know that sexual performance anxiety at the onset is treatable and not a major cause for concern. Feelings of uneasiness and anxiety may go away after the first sexual encounter with your partner. However, if you are experiencing sexual difficulties that make sex no longer enjoyable, it is wise to seek therapy and treatments to prevent SPA from developing into erectile dysfunction.
